MERCURIAL STOMATITIS. 129 



and that even under sacli conditions stomatitis may appear. Finally, it 

 should be remembered that all lesions of the kidney indicated by albumi- 

 nuria and other signs, and all lesions of the liver, favour poisoning by 

 checking or preventing the elimination of mercury by the kidney, or by 

 interfering with its transformation in the hepatic cells. 



Nature. Eegarding the essential nature of stomatitis, it would appear 

 (according to the work carried out in 1890 by Gallipe on mercurial stoma- 

 titis in mail), that we should regard it as a septic stomatitis, and not as a 

 primary toxic stomatitis. The mercury absorbed by the body not only 

 produces salivation, but a very important change in the chemical compo- 

 sition of the saliva. The vitality and toxicity of the saprophytic microbes 

 normally present in the buccal cavity appear gfeatly to increase, and 

 although only the most trilling erosions may exist in the mucous mem- 

 brane, true intra-mucous inoculation takes place, and forms the point of 

 origin for septic stomatitis. 



It has been found that it is not even necessary to have lesions in the 

 buccal mucous membrane ; in fact, this is the weak point in the theory 

 emitted. Nor is a modification in the chemical composition of the saliva 

 sufficient ; for when a mixture of iodine and the iodides, for example, is 

 being given, the saliva is chemically modified, and yet stomatitis, properly 

 so-called, does not occur. 



What seems most probable is that mercurial stomatitis is a toxi- 

 infectious stomatitis, in the development of which mercury acts primarily 

 by its toxic effect on the salivary glands, whose secretion it modifies, and 

 on the l)uccal epithelium, the renewal of which it checks. Infection of 

 the mucous membrane is thereby favoured, even in the absence of any 

 previous lesion, and stomatitis develops. 



Symptoms. The symptoms consist in abundant salivation with 

 discharge from the mouth, suggesting the existence of foot-and-mouth 

 disease. In grave cases the saliva appears streaked with blood, even 

 from the beginning. The buccal cavity exhales an intense foetid odour 

 which, during the following days, becomes more marked ; the mucous 

 membrane is pale in colour, and coated with a greyish exudate. The 

 mouth is hot and sensitive, the gums are swollen, reddish-violet in 

 colour, and painful. Alveolar periostitis soon sets in, the teeth become 

 loose, and mastication is rendered impossible, especially as the inflam- 

 mation causes the tongue to swell and lose its mobility. These 

 symptoms are unaccompanied by fever. 



In the last stage ulcerations and local necroses appear on the gums, 

 on the inner surface of the lips and cheeks, and around the commissures 

 of the lips. The patients are almost unable to feed, rapidly lose flesh, 

 become anaemic, and die from septic infection. The temperature is often 

 below normal. 



D.C. K 



